1. Milwaukee, Wisconsin April 30 – May 2, 2007
Welcome to the RUG n’ Roll Midwest & Great Lakes Regional User Group for Cerner Clients
Milwaukee, Wisconsin
April 30 – May 2, 2007

2. Interdisciplinary Teaching Records using PowerPlan Functionality
Lynn Germanson, RN, BSN
Senior Business Application Analyst
Clinical Documentation Team
Aurora Health Care, Milwaukee, WI
Lori Zareczny, RN, BSN
Business Application Analyst
Clinical Documentation Team
Aurora Health Care, Milwaukee, WI

3. Objectives
Describe the challenges of standardizing Teaching Record content across multiple disciplines and multiple facilities.
Describe how Interdisciplinary Teaching Records
have been interpreted by Aurora Health Care using
Cerner PowerPlan functionality.
Describe how Teaching Records have been built in
the electronic medical record for Aurora Health
Care facilities.

4. Who is Aurora Health Care?
Integrated Delivery Network
14 Hospitals ( beds)
120+ Outpatient Clinics
140+ Retail Pharmacies
Long Term Care
Home Health Services
Hospice Services
Laboratory Services
One of the nation’s “Most Wired” hospitals in 2004, 2005 & 2006
Private, non-profit, teaching organization:
684 employed physicians
3,200 physicians on staff
25,000 employees
$2.6 billion annual revenue
0.5 million IP days/year
2.3 million OP visits/year
0.25 million ED visits/year
0.3 million Home Care visits/ year
5.6 million retail Rx/year

5. Where is Aurora?

6. Diverse Hospital Mix 14 Hospitals Range from 40-600 beds
Include rural community hospitals and metropolitan acute care hospitals
Teaching facilities
Newly constructed and acquired facilities
Various levels of “Computerization”

7. Cerner Applications at Aurora
Hospital “Core” systems implemented from
Patient Access (Registration & Scheduling)
PowerChart Orders, Results, Charges
Radiology, Surgery, Emergency Dept
Interfaces: Lab, Transcription, Dietary, Digital Imaging
“Advanced” product implementations under way
PowerChart Office in Clinics (>75% done)
Pharmacy (100% done)
Multidisciplinary Clinical Documentation & eMAR (90% done)
PowerPlans & INet (14% done)
Teaching Records (1st site Go-Live Sept. 2007)
Barcode Medication Administration (new)
CPOE (7% done)

8. Teaching Record History
. . .first there was paper, then there were. . .
Online FORMS

9. Form Mimics Paper STOP! Ambulatory Surgery Teaching Record:
First area to capture teaching in Cerner
Form developed to capture their specialized teaching
Physical Therapy/Occupational Therapy:
Developed short list of common teaching topics
Speech, Nutrition, Nursing Other Disciplines. . .
Requested their “Own” teaching topics
STOP!

10. Ambulatory Surgery

11. Ambulatory Surgery

12. PT Teaching Record

13. Form Format? PROs Interdisciplinary
Pulls LCV, so can see what was taught previously
Customized to list specific teaching materials given
CONs
Each Topic requires 7 DTAs
Complex Event Set Hierarchy
Required teaching not identifiable
Unable to individualize
General Topics - Comment/note at bottom of page to be more specific
Maintenance nightmare
Teaching Records needed (>150)

14. The PowerGrid?

15. Prenatal Care Coordination Home Visit Teaching

18. PowerGrid Format
PROs
Useful for areas seeing patient over extended period of time (several months) with focused topics
Can select multiple topics in one entry
Allows individualization (comments)
LCV pulls previous teaching, allowing review in form
CONs
LCV pulls previous teaching, so resign others’ data each time
Several topics identified in each visit
Confusing to new care provider
One packed row vs. several rows in order to provide details about response to each topic
Inpatient build would be several forms with multiple sections because of variety of teaching topic groupers
Unable to identify Required Components

19. The Challenge

20. . . . Incorporate >150 paper teaching records x 14 site variations using different formats into something that will be. . .
Interdisciplinary
Individualized
Address Barriers to Learning for each learning session
Address components identified through evidence / regulatory standards
Allow easy review of previous charting
Standardized across a multi-hospital system

21. Teaching Records using PowerPlan Design
System Interdisciplinary Groups met several times to decide:
Diagnosis-based plans (CMS/Premier standards)
Subcategories in each Diagnosis Teaching Plan
Required components to meet set standards
Grouper Headers for other topic categories
Topic detail level
What is recorded about each topic – readiness, who, what, how, when, result

22. Diagnosis-Based Teaching Plans

23. Diagnosis-Based Teaching Plans
Congestive Heart Failure / CHF
Community Acquired Pneumonia / CAP
Total Joint Replacement / TJR
Cardiac Surgery
Acute Coronary Syndrome /AMI
Cerebral Perfusion Alteration / CVA
etc. . .

24. Conceptual Design - Subcategories in Diagnosis Teaching Plans

25. Subcategories in Diagnosis Teaching Plans
Disease Condition
Tests / Procedures
Treatments
Therapy / Equipment
Treatment
Medication Management
Functional Skills
Safety
Skills
Assistive Devices
Nutrition
Guidelines
Diet
Wellness
Advance Directives
Smoking
Discharge
Review Instructions
Home Monitoring
Community Resources / Home Care

26. Building Blocks Diagnosis-based Teaching Records
Plans Composed of Subcategory “Building Blocks”
Includes “Groupers” which exist independently for use without Diagnosis Teaching Plans
Diagnosis-based Plans Subcategory Groupers
Diagnosis
Disease Condition
Tests / Procedures
Nutrition
Guidelines
Diet
Treatments
Therapy / Equipment
Treatment
Wellness
Advance Directives
Smoking
Medication Management
Discharge
Review Instructions
Home Monitoring
Community Resources/
Home Care
Functional Skills
Safety
Skills
Assistive Devices

27. Using Cerner Functionality to Drive Teaching Record Format
Plans
Teaching Record category – “lives” after Discipline Plans
TEACH prefix helps in Plan Search window
Document In Plan
Interventions not Goals
Ready to Learn
Initial or Reinforcement
Who taught
Method of instruction
Evaluation of patient progress
Progress to Teaching Completion

28. Search and Select Teaching Plan

29. The Plan of Care “Homepage”

30. CHF Diagnosis Specific

31. CHF Treatments

32. CHF Medication Management

33. CHF Functional Skills and Nutrition

34. CHF Wellness

35. CHF Discharge

36. CHF Discharge cont.

37. Customize the Plan and Initiate

38. Only Selected Interventions Show

39. Document in Plan

40. Quick Chart

41. Linking to Form

43. Note/Variance Details

44. Teaching Documentation
Ready to Learn?
Initial vs. Reinforcement?
Who Taught?
Format Info Presented
Evaluation of Learning

45. Teaching Documentation

46. Any Questions ?